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Mandi Bishop is a hardcore health data geek with a Master's in English and a passion for big data analytics, which she brings to her role as Dell Health’s Analytics Solutions Lead. She fell in love with her PCjr at 9 when she learned to program in BASIC. Individual accountability zealot, patient engagement advocate, innovation lover and ceaseless dreamer. Relentless in pursuit of answers to the question: "How do we GET there from here?" More byte-sized commentary on Twitter: @MandiBPro.

Have you ever wondered whether YOUR healthcare data is included in the “big data” everyone’s talking about? After all, healthcare big data analytics are going to change the world; shouldn’t those changes be representative of the population they will impact?

To answer that question, we have to identify the sources of the healthcare big data being used to effect change, and consider the likelihood that your data may have been captured and consumed by one of the reporting organizations. So let’s start with the “capture” part of that equation.

Have you received some type of healthcare service this year? That includes, but is not limited to: hospital visit, physical therapy, doctor visit, chiropractor visit, urgent care visit, e-visit or phone consultation, health risk assessment or health fair.

Have you purchased or requested any regulated healthcare product this year, such as prescription drugs?

Do you have private health insurance?

Are you enrolled in Medicare or Medicaid?

If yes to any of the above, and the last question, in particular, YES, your data is included in the “big data” analytics currently shaping policy. It is likely that each billable product and service is attached to your Electronic Health Record, available for review and reporting by each involved party from your PCP (Primary Care Provider) to your friendly insurance call center agent. Your individual collection of data points are aggregated into a larger population, and sliced and diced to provide insights into groundbreaking research efforts. Congratulations! But does that inclusion mean that the conclusions driven by healthcare big data are representative?

By nature, the relevance of data-driven insights increases in proportion to the size of the population – and data points – included. But what if the outliers for the general population are the norm for your data set? Are your conclusions skewed?

What if you represent a population segment that is recognized as underserved? Consider the following, from the first Health Disparities and Inequalities Report, prepared in 2011 by the CDC (Centers for Disease Control): “Increasingly, the research, policy, and public health practice literature report substantial disparities in life expectancy, morbidity, risk factors, and quality of life, as well as persistence of these disparities among segments of the population…defined by race/ethnicity, sex, education, income, geographic location, and disability status.”

If your access to healthcare is limited by any of the factors indicated above, your data may not be captured unless/until there is an acute episode which requires medical intervention. In the report, the CDC acknowledges the challenge of capturing national data to support health initiatives for these populations; it is widely accepted as a barrier to healthcare equality that must be overcome.

What if you’re healthy? I’ll use myself as an example. I don’t go to the doctor unless it’s urgent, and I haven’t visited my PCP in over a year. I’ve injured my shoulder and my back over the past year, both of which required MRI and CAT scans to diagnose severity; however, I do not follow any medically supervised treatment plan for rehabilitation. I don’t take any routine prescription medication. I’m an exercise enthusiast who works out intensely 5-6 days/week, and I sleep 8-9 hours a night. Yes, I do sleep that much. And no, me putting all this information into a blog does not constitute the data being captured for use in healthcare big data analytics. Because I haven’t needed to go to my PCP lately, don’t take routine prescription medication, and am not of age for Medicare or income level for Medicaid, the only current healthcare data available for analysis for me is orthopedic in nature and revolves around imaging data, not traditional clinical measures. Someone like me who had NOT experienced an acute care episode would have no current data available for consumption and reporting as part of a larger population.

Could it be that much, if not most, healthcare big data cited for research purposes is comprised primarily of a triangle of outlier population segments: 1) oldest, 2) poorest, and 3) sickest?

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

For those of you who missed the news, Pri-Med acquired Amazing Charts EHR for a currently undisclosed amount. This was a really interesting move in the EHR industry. Anne Zieger suggested that this and other indicators was a sign of EMR consolidation. Turns out there’s a lot more behind the Pri-Med acquisition of Amazing Charts than most people would see on the surface.

In a call I had with Amazing Charts founder and president Dr. Jonathan Bertman, as well as John Mooney, founder and CEO of Pri-Med, I learned a lot about why this acquisition makes sense and how they’re planning to capitalize on the investment.

CME Chart Level Review
One of the most interesting things I learned was that chart level review was the best way to see the gaps and needs that can be satisfied by CMEs. Considering Pri-Med is a major player in the CME space, you can see the value that having relationships with a bunch of doctors using an EHR can be for them. I didn’t dive into how Pri-Med plans to leverage the Amazing Charts EHR charts, but you can see the possibilities. Although, Amazing Charts is a mostly client-server based EHR, so Pri-Med won’t have any access to do chart level reviews without permission from the doctors using the EHR.

Protecting EHR Data
In fact, in my discussion I learned that Dr. Bertman and John Mooney both had no interest in using a physician’s EHR data to make money. That philosophy actually seemed to bring Pri-Med and Amazing Charts together to make this acquisition happen. Both believe that their company should make money providing the software and services a doctor needs as opposed to making money off the data in an EHR. This is nothing new since I’ve heard Dr. Bertman espouse this belief many times before, but does contrast with other EHR vendors in the market.

EHR Acquisition Options
I was also fascinated to hear about Dr. Bertman’s thoughts on Amazing Charts approach to acquisition. He said that he didn’t want Amazing Charts users to experience what other EHR users had experienced when their EHR was acquired by another EHR company. He didn’t want Amazing Charts to be one of many EHR software in a company’s portfolio. Inevitably, EHR software will get sunset to streamline the company and Dr. Bertman didn’t want that for his users.

What does the Acquisition Mean for Users?
Ont thing users of Amazing Charts can expect is efforts to create clinical training and information at the point of care. John Mooney mentioned their “5 Minute Clinical Consults” as a model of short education that could be integrated into the clinical documentation process. I’ll be interested to see how this evolves. Even 5 minutes seems too long for most doctors to stop their patient workflow. However, it is interesting to bring Pri-Med’s education knowledge, experience and library to the point of care in the Amazing Charts EHR.

I also was fascinated by John Mooney’s suggestion of Amazing Charts possibly integrating a Provider Self Assessment tool into Amazing Charts. Definitely makes sense to have the doctors self assess to get the best CME. While not a perfect match inside an EHR software, it doesn’t seem completely out of place in the EHR if it’s done right.

Amazing Charts User Groups at Pri-Med Events
I also learned that they’ll be working to hold Amazing Charts user group meetings at the various Pri-Med events. This could be a great boon for Amazing Charts users. I know a lot of doctors and their staff won’t or can’t attend the national user group meetings that most EHR vendors hold. I’m not sure where the 6500 Amazing Charts users are found throughout the country, but if planned well it would be great to leverage the existing Pri-Med events for this and engage more of their EHR users close to home.

Post-Acquisition Logistics
They told me that Amazing Charts would maintain a separate entity in Rhode Island to continue developing and supporting the EHR software. Their marketing and sales would come out of Boston where Pri-Med is located. For Amazing Charts users, this sounds like it will be mostly business as usual from their perspective. In fact, it could mean Amazing Charts has more resources available to build our their EHR software. All in all, this seems like a smart move for Amazing Charts and their users.

Full Disclosure: Amazing Charts is an advertiser on this site, but you can be sure I’d cover every EHR acquisition I can find.

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I was recently contacted by Waiting Room Solutions, an EHR company located in New York City about their experience during Super Storm Sandy. Sandra Levy talked to a number of Waiting Room Solutions EHR doctors to learn about their experience with EHR during Super Storm Sandy. She tells their stories in the embedded PDF below (try the full screen button for easy reading).

Mandi Bishop is a hardcore health data geek with a Master's in English and a passion for big data analytics, which she brings to her role as Dell Health’s Analytics Solutions Lead. She fell in love with her PCjr at 9 when she learned to program in BASIC. Individual accountability zealot, patient engagement advocate, innovation lover and ceaseless dreamer. Relentless in pursuit of answers to the question: "How do we GET there from here?" More byte-sized commentary on Twitter: @MandiBPro.

Much hullaballoo is made over the 47% increase in Medicare payments from 2006-2010, which some seem eager to attribute to the adoption of EMR. The outcry is understandable; a 47% increase is a big dang deal, and taxpayers should be concerned. But haven’t we all heard that statistics lie?

“Hospitals received $1 billion more in Medicare reimbursements in 2010 than they did five years earlier, at least in part by changing the billing codes they assign to patients in emergency rooms,” cited the New York Times based on analysis of Medicare data from American Hospital Directory. Indeed, billing codes have changed from 2006-2010, in accordance with the HCPCS (Health Care Procedure Coding System) reform of CPT (Current Procedural Terminology) application and inclusion guidelines, cited here: HCPCS Reform from CMS. Healthcare industry growth and care advances drove an increase from 50 – 300 new CPT code annual applications between 1994-2004, leading to sweeping change in the review and adoption process starting in 2005 – including elimination of market data requirements for drugs.

Think about that for a second. If Pharma no longer has to submit 6 months of marketing data prior to applying for an official billing code, how many new CPT codes – and resultant billing opportunities – do you think have been generated by drugs alone since that HCPCS process change adoption in 2005? Which leads me to my next correlating fact: the most significant Medicare Part D prescription drug provisions did not start until 2006.

Let’s put two and two together: Medicare Part D prescription drug coverage (2006) + change in HCPCS billing code request process to speed drugs to market adoption (2005) = significant increase in Medicare reimbursements. To use the NYT analyst language, “in part”, administration of those drugs occurs in an emergency room. And who might be in the ER on a regular basis? I’ll give you a hint: “I’ve fallen, and I can’t get up!”

Perhaps the most profound contributor to this Medicare reimbursement increase is a recent dramatic rise in the Medicare-eligible population. Per the National Institute on Aging’s 65+ in the United States: 2005, the 65+ population is expected to double in size between 2005 and 2030 – by which point, 20% of the US will be of eligible age. The over-85 age group, as of 2005, was the fastest-growing population segment. Elderly people who are prone to chronic conditions as well as acute care events just might lead to higher Medicare reimbursements.

Of course, there are myriad contributing factors. Some industry analysts attribute the rise in Medicare claims cost to fraud, citing that the workflow efficiencies that the EMR technology provide allow for easy skimming. Activities such as “cloning”, or copying and pasting procedures from one patient to the next with minimal keystrokes within the EMR software, might contribute to false claim filing for procedures that were never performed. While the nefarious practice of Medicare fraud long predates EMR, the opportunity to scale one’s fraudulent operations to statistically relevant proportions increases significantly with automation. And as my mother always told me, it only takes one bad apple to spoil the bushel.

But how many bad apples would it take to spoil a multi-billion dollar bushel to the tune of a 47% cost increase? According to the NYT article, “The most aggressive billing — by just 1,700 of the more than 440,000 doctors in the country — cost Medicare as much as $100 million in 2010 alone,” and the increase in billing activity for each of those 1700 occurred post-EMR adoption. After all, “hospitals that received government incentives to adopt electronic records showed a 47 percent rise in Medicare payments…compared with a 32 percent rise in hospitals that have not received any government incentives.”

Wait, did that statistic just indicate a significant increase in Medicare reimbursements, across the board? So the differential between those providers who have received government incentives for EMR adoption, and those who have not, is 15%. The representative facilities and providers responded to the “aggressive billing” accusation by indicating that they had 1) more accurate billing mechanisms, 2) higher patient need for billable services. I’ll buy that. Sure, it’s likely that there is Medicare fraud happening, but that’s not new – it’s unfortunate that there will always be ways to game the system, whether manual or electronic. But is the increase in “fraud” pre and post-EMR adoption statistically relevant?

Considering the complex variables involved, I’ll chalk up the 15% increase to the combination of more specific billing practices, Medicare Part D drug provisions, an aging population and the health issues which accompany it, and not vilify the technology which facilitates further advances. Let the EMR adoption expansion continue!

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

This week is the enormous RSNA conference in Chicago. I almost made the trip to the event, but wasn’t able to figure out the logistics. Plus, with a wife and kids the less travel the better. One day I’ll make it to RSNA. Until then, I thought I’d dedicate this edition of Meaningful Use Monday to the radiologists out there.

In short, meaningful use stage 1 was not good for radiologists. Most radiologists saw it as a non-starter for them. In fact, I think it’s safe to say that smaller radiologists couldn’t tell you much of anything about meaningful use stage 1. Meaningful Use stage 2 has made some progress for radiologists, but is unlikely to really get them off the bench and showing meaningful use.

Healthcare IT News has a good article on radiologists and MU where they point out some image centric updates to meaningful use per RSNA:

compliance exemptions for many hospital-based providers who are not involved in their facility’s information technology decisions, a discretionary menu set objective targeted toward diagnostic image accessibility in EHRs, recommendations for radiology-relevant clinical quality measures, more flexible definitions of what constitutes justified EHR, and a consolidation of the eligible hospital and eligible professional technology certification criteria.

Although, the article also points out two other very important points. First, radiology practices will likely forgo participation in the meaningful use program and avoid the EHR financial penalties by way of an exemption. If that exemption ever runs out, then radiologists might change their tune. Although, my guess is that the meaningful use penalties will never be enforced or that there will always be exemptions that radiologists can fall back on.

The second point is even more interesting. Lineage Consulting’s Nakhle suggests that all of the other ordering physicians that are adopting EHR and showing meaningful use might be the real driver for radiologists to get on board meaningful use. I agree that ordering physicians being meaningful users of an EHR is going to change imaging facility requirements. Certainly imaging facilities are going to have to work on new tech workflows, but that doesn’t mean they have to go so far as meet meaningful use. Plus, most imaging facilities are working on these workflows already, so I don’t expect meaningful use will cause much change.

I’m sure this will be a huge topic of discussion at RSNA. If you’re there, we’d love to hear what’s being said on the show floor.

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

A Shortcut to Wasted Time nyti.ms/QdK9Lq On the pitfalls of EMR documentation.

This article is one of the most thoughtful pieces I’ve read about the challenges and benefits of EMR versus paper charts. It hits the nail on the head of the opportunities that are available with EMR, but also the stark realities of what’s happening with EMR implementations as well. Go read it and I think you’ll agree.

International survey shows two-thirds of US primary care docs using electronic medical records, up from 46% in ’09 ow.ly/fttKR#EMR

I’m always suspicious of EMR adoption rates that are put out there. This one puts EMR adoption at 69%. What I think is more significant is the change in EMR adoption rate from their previous survey in 2009 where EMR adoption was at 46%. A 23% increase in EMR adoption is definitely a trend, but we didn’t need a survey to tell us that shift was happening.

Ok if one more nurse writes “please see!!!!!” in the EMR next to a stable pt who’s simply annoying I’m going to set fire to this place.

You should probably just go read all of Dr. Killpatient on Twitter. Yes, I’m sure many of you will cringe at what’s tweeted. I did in some cases too, but it is a really transparent look into one ER doc’s views. I wonder what his nurses would think of the tweet above. It’s also interesting what’s documented in the EMR. I wonder what Dr. Killpatients note looked like. Probably not as specific as the tweet.

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I’ve mostly taken a bit of time off to enjoy Thanksgiving with the family. I hope you’re doing the same and enjoying the start of the holidays.

For those of you still grinding away, I thought I’d throw out a thought that one of my readers told me in an email discussion we were having. They suggested that at some point they believed that the HIE (Health Information Exchange) would be a way to get new patients. They admitted that it wasn’t the original intent of the HIE, but was still a likely outcome.

I’ve been thinking quite a bit lately about how to drive new patients to a doctors office for my new Physia venture. Although, I have to admit that I hadn’t been thinking about HIE as a way to get new patients. I’ll be chewing on that a little bit this holiday weekend. I’d love to hear other non-traditional ways you’re using to find new patients.

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

One of the companies I met in New York City at the Digital Health Conference was MedCPU. I had a great time talking with the effervescent Founder and President, Sonia Ben-Yehuda and the Founder and CEO, Eyal Ephrat, MD. MedCPU is part of the inaugural New York Digital Health Accelerator class. Plus, they’ve created a pretty interesting concept and way to simplify their message down to a single button that analyzes both free text notes and structured data to check for compliance to best practice guidelines or for deviations from expected care.

The idea of a single button that does all the work is a decent one. Sure, real time analysis is good as well, but EHR software isn’t there yet and won’t be for a while to come. Very few EHR seem to be offering real time meaningful use compliance checking. Forget about real time clinical compliance checking.

What I found even more interesting was something that MedCPU told me when they were describing their product. Dr. Ephrat told me that one hospital was using the services MedCPU provides as the benefit that doctors will receive for using EHR. I find this concept quite interesting. I won’t belabor the point that EHR is the database of healthcare, but it’s amazing to consider that a third party application could provide enough benefit to be the reason why doctors want an EHR.

Many EHR vendors realize this is true. That’s why many are trying to offer API (application interfaces) which will allow third party vendors to interact and integrate with their EHR. I wonder what apps can be created by third parties that would really take EHR software to the next level. A thriving third party eco-system of developers can be much more powerful than trying to do all the innovation in house.

Do you know of other EHR add-ons that provide the real benefits physicians want out of an EHR? I’d love to hear of ones you think fit that test.

Anne Zieger is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

When talk turns to HIPAA, most of us are focused on privacy compliance. After all, privacy is a complex, expensive nightmare, and few hospitals or medical practices feel up to the task, so talking through those issues makes sense.

But as blogger Art Gross points out, the HIPAA Security General Rules require more than protecting a patient’s privacy. They also require that ePHI remains available even in the face of disaster. From the rules (courtesy of Gross, emphasis his):

§ 164.306 Security standards: General rules.
(a) General requirements. Covered entities must do the following:
(1) Ensure the confidentiality, integrity, and availability of all electronic protected health information the covered entity creates, receives, maintains, or transmits.

Apparently, far too few healthcare providers are paying enough attention to this part of the rules. Gross, who is a HIPAA security consultant, says that when he audits organizations, few have disaster recovery or emergency operations procedures in place.

Now, big enterprise IT departments aren’t going to leave disaster recovery out of their planning; it’s simplly part of the drill for any large installation. But the smaller the provider group gets — particularly when you zoom down to one to three-doctor practices — the story changes.

As people who read blogs like this one know, smaller practices aren’t likely to have so much as a single IT staffer on board. Keeping their EMR up and running is enough of a burden. I’m not at all surprised to hear that they aren’t prepared for disasters like Hurricane Sandy, which brought down even large medical centers.

But with HIPAA demanding immediate access to ePHI, doctors won’t have a choice much longer. And hospitals will want to make sure independent doctors aren’t the weak link in the availability chain.

Yes, it’s asking a lot of small practices to make intellligent disaster recovery plans for their EMR, and even more of their hospital partners if they want to keep access to disparate EMRs out there. But there’s just no getting around the problem.

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

The big meaningful use news this week was the release of the meaningful use stage 3 recommendations (PDF) that the meaningful use workgroup released to the public. Some on Twitter thought that this was the meaningful use stage 3 rule that could be commented on. This is not open for public comment yet, but should be soon.

In fact, Healthcare IT News listed the following timeline for meaningful use stage 3:

Dec. 21, 2012 – RFC deadline

January 2013 – ONC to synthesize the RFC comments for HIT Policy committee workgroups to review

February 2013 – The workgroups will reconcile RFC comments

March 2013 – The workgroups will present a revised draft of Stage 3 requirements to ONC

April 2013 – ONC is expected to approve final Stage 3 recommendations

May 2013 – ONC will transmit final Stage 3 recommendations to HHS

That’s a pretty aggressive timeline to have meaningful use stage 3 published by May 2013. If my dates are right, meaningful use stage 3 won’t be effective until 2016. I like that ONC wants to get the MU stage 3 out soon so that no one can use not having the meaningful use details as an excuse for not complying. However, I also don’t think ONC should rush the process either. We have to live with meaningful use, good and bad, for a long time to come.

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